[Developments and inventions from Germany : Influence on international ophthalmology]. / Entwicklungen und Erfindungen aus Deutschland : Einfluss auf die internationale Augenheilkunde.

There are various developments and inventions from Germany that have influenced not only the domestic but also the international field of ophthalmology. Beginning with the invention of the ophthalmoscope by Hermann von Helmholtz in 1850, to the establishment of the "Archives of Ophthalmology" medical journal, a publication founded by Albrecht von Graefe in 1854, through to the development of the retinal chip by Eberhart Zrenner and colleagues with the first clinical data collected in 2007. The abovenamed and further developments and the German ophthalmologists behind these inventions are discussed in more detail.

[Can Postoperative Accelerated Lens Opacification be Limited by Lying in "Face-Down Position" after Vitrectomy with Gas as Tamponade?]. / Kann eine postoperativ beschleunigte Linsentrübung nach einer Pars-plana-Vitrektomie mit Gas als Tamponade durch eine konsequente "Gesicht-nach-unten-Lagerung" vermieden werden?

BACKGROUND: Developing a post-operative cataract after pars-plana vitrectomy (ppV) or core pars-plana vitrectomy (cppV) with gas as tamponade within 6 to 12 months is a common complication and is mostly accepted as unavoidable. Often a combined cataract-ppV surgery in the first place is recommended. The main goal of this study was to analyse the effects of a "face-down positioning" ("fdp") on the lens transparency and the phaco rate. By using the positive experience of an ergonomic body positioning it should be possible to improve the compliance during the period of "fdp" after surgery. METHODS: During the study period of up to 24 months, we observed in a prospective, controlled, clinical and randomised pilot study 30 patients who all had undergone a ppV/cppV with sulfur hexafluoride gas tamponade (SF6 25 %). All patients of the supported group (SG) and the control group (CG) were requested to keep their face consequently downwards until the gas bubble was resorbed completely in order to avoid a direct contact with the lens. The real time in "fdp" in hours per day (24 hours) and the grade of lens opacification was documented pre- and postoperatively using a Pentacam HR (Oculus, Wetzlar). RESULTS: The compliance of patients tested measuring the real time of "fdp" in hours per day varied largely (SG: 19.5/24; CG: 5.5/24; p < 0,0001). Cataract development was found to be directly related to the real time of "fdp". A cataract surgery was necessary mainly in the non-supported group (SG: 4/15; CG:12/15; p = 0.012). There was no lens opacification in the supported group after performing the "fdp" for at least 20 hours daily until the resorption of the gas bubble was completed. This result did not correlate with the age of the patient. CONCLUSION: With the help of sufficient support at the disposal of the patients, it is possible to significantly improve the compliance during the period of "fdp" after surgery. In order to get a safe and painless "fdp" in bed, an ergonomic body positioning is necessary (Schaefer 2012). By practicing the "fdp" until the gas bubble is completely resorbed, the risk of developing a postoperative cataract can be reduced significantly. Provided there is a good compliance to "fdp", the gas bubble can cause the desired tamponade effect even when using shorter acting gases. By performing a consistent "fdp" it is possible to accelerate the healing process and avoid reoperations. Hereby it should even be possible to use an SF6-air mix or optionally simply air as tamponade.

[Accessibility of information on eye diseases on the internet for the visually impaired user]. / Zugänglichkeit von Informationsangeboten über Augenerkrankungen im Internet für sehbehinderte Nutzer.

BACKGROUND: The number of visually impaired people who use the internet for obtaining health information around the eye, is rising continuously. For this reason the accessibility for visually impaired persons to such websites is an important factor. Our investigation deals with the question: How good is the accessibility for the visually impaired to gather information on eye diseases on the Internet and how could this be improved? MATERIALS AND METHOD: After identification using the the search engine "Google", 20 websites of German university eye hospitals have been checked for their accessibility using the modified BITV test which is based upon 52 test criteria. RESULTS: On average 70.75 % (+/- 6.19 % min. 56.6 %, max; 86.79 %) of the required accessibility criteria have been fulfilled. This corresponds to an average accessibility value of 70.58 % (+/- 6.69 % min. 56.31 %, max. 89.32 %). According to the BITV test, this means that the average of the analysed websites is not accessible. The improper use of mark-up languages, unclear document or web page titles or missing alternative texts for pictures, graphics and navigation elements and misleading navigational architecture are frequent findings. This builds up the greatest accessibility barriers, although these barriers could be eliminated even with a relatively low expense. CONCLUSION: Good accessibility allows not only a barrier-free access to information for visually impaired users but is also a most important feature related to search engine optimisation.

[Optical quality after refractive corneal surgery]. / Optische Qualität nach refraktiver Hornhautchirurgie.

Correction of myopia, hyperopia and astigmatism within its indicated margin by means of refractive corneal surgical procedures such as LASIK and surface ablation (e.g. PRK) is one of the standard procedures in ophthalmology. Now that advances in the fields of surgical techniques and the technical devices employed have further progressed in terms of safety and predictability, research also focuses on optical quality. "Optical quality" is not a clearly defined parameter, but can be captured indirectly by means of directly measured data. One has to start with the anatomical properties of the eye, which determine the optical images on the retinal level. The quality of the retinal image influences the eye's function, i.e. acuity and contrast perception. Finally, there is the subjective perception of the image we receive. "Optical quality" as such is reflected by the patient's evaluation of this image perception. Three phenomena are especially responsible for deterioration of the quality of the retinal image: diffraction, aberrations and dispersion. Some of the methods for measuring optical quality are subjective questionnaires, functional testing procedures for measuring visual acuity and contrast sensitivity, optical measuring procedures for the determination of optical quality, as well as biomicroscopy, aberrometry and corneal topography for assessing anatomical changes.

[LASIK with a superior hinge and scanning spot excimer laser ablation for correction of myopia and myopic astigmatism. Results of a prospective study on 100 eyes with a 1-year follow-up]. / LASIK mit superiorem Hinge und Scanning-Spot-Excimerlaserablation zur Korrektur von Myopie und myopem Astigmatismus. Einjahresergebnisse einer prospektiven klinischen Studie an 100 Augen.

PURPOSE: Recently laser-in-situ-keratomileusis (LASIK) has been increasingly used to correct refractive errors. The purpose of this investigation was to evaluate the safety, efficacy, predictability, stability and complications using the scanning spot excimer LASIK technology. PATIENTS AND METHODS: The results of 100 consecutive LASIK operations carried out between 2/1998 and 2/1999 on 60 patients (mean age 37 years, range 20-55 years) have been evaluated. The Hansatome microkeratome with a superior hinge (flap diameter: 9.5 mm) and a scanning spot excimer laser (Technolas C-Lasik 217) were used in all cases. The mean spherical equivalent of the subjective manifest refraction was -6.96 +/- 2.87 diopters (D), the mean sphere was -6.47 +/- 2.71 D and the mean astigmatism was -0.98 +/- 0.94 D. In 6% of the eyes preoperative visual acuity was not better than 20/40. Examinations were performed preoperatively, after 1 and 7 days, after 1,4 and 12 months. Safety, efficacy, predictability, stability and complications were calculated using the datagraph software (version 1.11). RESULTS: All 100 eyes were examined after 1 day and 1 week, 96 after 1 month, 95 after 4 months and 92 after 1 year. Following 1 year none of the eyes lost 2 or more lines of best corrected visual acuity, 99% were within +/- 1 line and 1% gained 2 lines (safety index 1.03). In 92% of all eyes an uncorrected visual acuity of > or = 0.5 was reached, in 77% > or = 0.8 and in 51% > or = 1.0 (efficacy index 0.89). For 60 eyes (65.21%) a refractive correction of +/- 0.5 D was necessary, for 82 eyes (89.13%) +/- 1.0 D and for 91 eyes (98.91%) +/- 2.0 D. The mean spherical equivalent after 1 year was -0.15 +/- 1.31 D. Between 1 and 12 months a mean regression of -0.14 D occurred. On the request of the patients, 5 eyes were retreated during the study period for under- or over-correction. Complications due to the microkeratome did not occur. Corneal infections were not observed, a diffuse lamellar keratitis (DLK) was seen in 12 cases, but all cases healed with no loss of visual acuity. In 7 eyes a slight decentration of the ablation was observed using corneal topography, which in one case caused an increase in glare sensitivity. CONCLUSIONS: LASIK with superior hinge and scanning spot excimer photoablation is suitable for the correction of myopia (up to a maximum of -12 D) and for myopic astigmatism (up to a maximum of -5 D). The refractive results showed a high stability during the 12-month study period but there is still room for improvement of the predictability.

[Scheimpflug photographic imaging following implantation of anterior and posterior chamber phakic intraocular lenses: preliminary results]. / Scheimpflug-fotografische Untersuchungen nach Implantation phaker Vorder- und Hinterkammer-Intraokularlinsen: Erste Erfahrungen.

BACKGROUND: For the correction of refractive errors lenticular procedures are increasingly used in addition to corneal refractive surgery. One of those techniques is the implantation of intraocular lenses into phakic eyes (pIOL). Due to the close neighborhood of the implant to delicate intraocular structures, exact positioning and high postoperative stability are required. Scheimpflug photography has been shown to be a suitable instrument for the biometry of the anterior eye segment and the examination of IOL position. PATIENTS AND METHODS: Four anterior chamber phakic IOLs (pIOLs) (Bausch & Lomb NuVita) and 7 posterior chamber pIOLs (Staar ICL) were examined 1 week, 1 month and 3-6 months following implantation. At each examination 1 Scheimpflug slit image and 1 infrared retroillumination image were taken using the anterior eye segment analysis system EAS-1000 (Nidek Co., Gamagori, Japan). Evaluation of the images was performed with a personal computer and the software provided by the manufacturer. The distance of the pIOL to cornea and human lens was calculated and incidence and amount of pIOL rotation around the optical axis and potential crystalline lens opacification were assessed. RESULTS: The distance between the anterior chamber pIOL and the cornea 1 week after implantation was 1.61 +/- 0.10 mm. The distances between the myopic posterior chamber pIOL and the human lens were 0.34 +/- 0.11 mm and between the hyperopic posterior chamber pIOL and the human lens 0.26 and 0.29 mm, respectively. The values were constant over a period of 3-6 months. The pIOL showed no movement or change of position around the optical axis. There was no detectable cataract formation in the human lens. CONCLUSIONS: All implanted phakic anterior and posterior chamber IOLs showed a stable position in the eye within the observation period. Scheimpflug photography is proved to be a useful technique for the postoperative evaluation of the positioning of phakic IOLs.

[Photorefractive/photo-astigmatic refractive keratectomy in low myopia and myopic astigmatism. Broad beam versus scanning spot laser technology]. / Photorefraktive/photoastigmatisch-refraktive Keratektomie bei niedriger Myopie und myopem Astigmatismus. Broad-beam versus Scanning-spot-Lasertechnologie.

PURPOSE: The results of photorefractive/photoastigmatic refractive keratectomy (PRK/PARK) were compared between two patient groups treated consecutively with either broad-beam or scanning-spot technology. PATIENTS AND METHODS: PRK/PARK was performed with a broad-beam excimer laser VISX 20/20 in 46 eyes and with the scanning-spot laser system Keracor 217 in 49 eyes. Preoperative spherical equivalent (subjective manifest refraction) was < or =-6.0 diopter in both groups. Safety, efficacy, predictability, stability, and complications were investigated after 1,4 and 12, months postoperatively. RESULTS: In the broad-beam laser group no eye lost two or more lines of best-corrected visual acuity;in the scanning-spot laser group one eye lost two lines 12 months postoperatively. Efficacy, predictability, and stability were comparable between the two groups. CONCLUSIONS: Both the broad-beam and the scanning-spot laser provided good results after PRK/PARK for low myopia and myopic astigmatism. This study found no fundamental differences between the two laser systems.

[Intra-individual comparison of intraocular lenses of highly refractive silicone (Allergan SI40NB) and hydrophobic acrylate (Alcon Acrysof MA60BM). 1-year follow-up]. / Intraindividueller Vergleich von Intraokularlinsen aus hochrefraktivem Silikon (Allergan SI40NB) und hydrophobem Acrylat (Alcon Acrysof MA60BM). 1-Jahresergebnisse.

BACKGROUND: A prospective, randomized study was performed to evaluate intra-individually the biocompatibility of foldable, highly refractive silicone and hydrophobic acrylic intraocular lenses (IOL). MATERIALS AND METHODS: We studied 35 patients who underwent phacoemulsification using a self-sealing tunnel incision. In a randomized fashion one eye received a 6-mm optic IOL made of high-refractive index silicone (Allergan SI40NB) and the other eye a hydrophobic acrylic 6-mm optic IOL (Alcon AcrySof MA60BM). All patients were examined 7 days, 1-3 and 6 months, and 1 year postoperatively. RESULTS: The mean best-corrected visual acuity (BCVA) was 0.9 +/- 0.12 vs. 0.89 +/- 0.13 (SI40NB vs. MA60BM) after 1-3 months. One-year postoperatively BCVA was still 0.9 +/- 0.12 vs. 0.87 +/- 0.14. The flare values (photon counts/ms) increased slightly 7 days after surgery (14.2 +/- 8.68 vs. 15.49 +/- 7.2, n.s.). Three months after surgery these values were again in the normal range. The mean IOL decentration was 0.29 +/- 0.14 vs. 0.3 +/- 0.15 mm 1 year postoperatively. Scheimpflug slit photography showed 40% of MA60BM IOLs to have "glistenings." No significant difference regarding posterior capsular opacification was found. CONCLUSION: One year after implantation of foldable, highly refractive silicone and hydrophobic acrylic IOLs using a self-sealing tunnel incision and phacoemulsification, no significant functional or morphological differences between the two IOL types were observed.

[[In vitro culture of iris cells]. / Kultivierung von Iriszellen in vitro.

BACKGROUND: The biological behaviour of iris cells in vitro was not yet completely investigated. For a more detailed study of the scope of cultivation of iris cells in vitro we isolated human iris pigment epithelium (IPE) cells and iris fibroblasts. MATERIALS AND METHODS: For the purpose of this study iris cells were isolated from 19 donor eyes. A method was established for isolation and cultivation of IPE cells by means of fibronectin coating and the use of a special cell culture medium. Additionally, a method was developed for the selection of fibroblasts from iris stroma (IS) in vitro by means of fibronectin coating, passaging and proliferation in cell culture medium. RESULTS: The IPE and IS cells could be cultivated successfully. The IPE cells started to divide after a mean interval of 5.4 +/- 0.7 days in culture. The mitosis of IS cells was observed after 3.3 +/- 0.87 days in culture. Confluency of IPE cells was reached after 14.7 +/- 4.92 days and by IS cells after 8.1 +/- 1.45 days. Immunocytochemical staining using two antibodies for cytoceratin and one for human fibroblast showed that the IPE cell culture was pure and that the IS culture consisted of fibroblasts. Furthermore, electron microscopy of IPE and IS cultures confirmed the results of the immunocytochemical staining. CONCLUSIONS: The use of human IS and IPE cells in vitro has established a novel model for the research on iris cells. The model might possibly be applied in the research of metabolic structures and diseases of the iris.

[Photoastigmatic refractive keratectomy for low, moderate, and high astigmatism using a broad beam excimer laser: evaluataion according to new international criteria]. / Photoastigmatische refraktive Keratektomie für gering-, mittel- und hochgradig myope Astigmatismen mit einem Broad Beam Excimer Laser: Auswertung refraktiv-chirurgischer Daten nach internationalen Richtlinien.

BACKGROUND: Photorefractive keratectomy (PRK) is an accepted procedure to correct myopia in Germany. The purpose of this study was to evaluate photoastigmatic refractive keratectomy (PARK) for myopic astigmatism. MATERIAL AND METHODS: PARK using the VISX 20/20 excimer laser was performed in 50 eyes of 36 patients (25 female, 16 male) aged 22 to 68 years (mean 38 +/- 10 years) in the period of 1995 to 1996. Retrospective evaluation was done after dividing the patients into three astigmatic groups between -0.5 diopters (D) and -1.5 D (group I, n = 28), between -1.75 D and -3.0 D (group II, n = 16) und between -3.25 D and -5.5 D (group III, n = 6). The correction of myopic astigmatism was assessed concerning the criteria safety, efficacy, predictability and stability. Mean follow-up was 12 months (8-15 months). RESULTS: Seventy-eight % of all eyes achieved an uncorrected visual acuity of > 0.5. Sixty-eight % of the eyes were within +/- 1.0 D of the desired correction. Loss of 2 or more lines of best corrected visual acuity occurred in 6 eyes (12.0%). We observed in group I an astigmatic reduction of 36.0%, in group II of 66.5% and in group III of 68.0%. The surgically induced astigmatism was calculated with 1.29 +/- 1.0 D. Mean axis rotation of the refractive cylinder was 22.12 +/- 23.05 degrees. CONCLUSIONS: PARK using the VISX 20/20 excimer laser is an acceptable procedure to correct myopic astigmatism. However, the study revealed that astigmatic reduction with a broad beam laser is not yet perfect in terms of efficacy, predictability and safety.

Visual outcome after treatment with low-dose recombinant tissue plasminogen activator or hemodilution in ischemic central retinal vein occlusion.

The ischemic type of central retinal vein occlusion (CRVO) is associated with a poor visual and ocular prognosis. Although several reports have indicated that hemodilution or thrombolytic therapy may be of benefit, there is still no consensus among ophthalmologists about the management of this disorder. In our study, we retrospectively evaluated the visual outcome after medical treatment in 58 patients with ischemic CRVO and severe visual loss (< or = 20/50). We separately investigated three different groups, depending on the following criteria: onset of symptoms within 11 days prior to admission and thrombolytic treatment with 50 mg of recombinant tissue plasminogen activator (rtPA) and intravenous heparinization (n = 23) or hemodilution therapy (n = 22) or onset of symptoms >11 days before the initial visit and hemodilution (n = 13). An advancement of 2 or more lines on the logarithmic visual acuity chart was noted in 10 cases (44%) in the rtPA group and in 3 subjects (14%) in the early-phase hemodilution group, whereas only 1 patient in the late-phase hemodilution group showed a comparable improvement. Our findings suggest that treatment with low-dose rtPA or hemodilution aimed at early restoration of blood flow has the potential to improve the visual prognosis in ischemic CRVO. The finding that thrombolysis had a favorable outcome supports the hypothesis that specific subgroups of patients may benefit from this therapeutic approach. Further investigation will be required to definitively prove the effectiveness of fibrinolytic agents.

Complications after implantation of intraocular devices in patients with cytomegalovirus retinitis.

PURPOSE: The authors report their surgical experience after sustained-release ganciclovir treatment, as well as replacing empty ganciclovir implants in patients with acquired immune deficiency syndrome (AIDS) and cytomegalovirus (CMV) retinitis. METHODS: Between November 1995 and August 1998, 79 eyes of 49 patients received 99 intravitreal ganciclovir implants. Patients were examined monthly after implant surgery. Follow-up periods ranged from 6 to 128 weeks. RESULTS: At the first 3-week postoperative visit, 73 eyes (97.2%) of 46 patients exhibited stable conditions. In 6 eyes (3.8%) of 3 patients, further progression was noted due to resistance to ganciclovir. The most common early complication (within 6 weeks after implantation) was cystoid macular edema, observed in 7 eyes receiving implants. Retinal detachment was the most common late complication (over 6 weeks after implantation) in 11 eyes. In almost all eyes with CMV retinitis and retinal detachment, involvement of more than 25% of the retina was observed. Additional severe complications included extrusion of the first pellet in 2 eyes and cataract as a late complication in 5 eyes. A total of 28 eyes (35.4%) of 16 patients receiving a second implant did not experience significant three-line loss by the end of the follow-up period. CONCLUSION: In the treatment of CMV retinitis, sustained-release ganciclovir implantation seems to be an alternative to intravenous ganciclovir. Early implantation and additional replacement of the device has the potential to decrease the risk of developing retinal detachment. We would recommend additional systemic antiviral CMV therapy to avoid infection of the fellow eye and CMV disease.

Stereopsis after primary in-the-bag posterior chamber implantation in children.

PURPOSE: The purpose of this study was to evaluate visual acuity and binocular function after primary posterior chamber intraocular lens (IOL) implantation in children. PATIENTS AND METHODS: A retrospective chart review of 39 eyes of 31 children was performed. Fifteen eyes with traumatic, 17 with developmental, and 7 with congenital cataracts without any other ophthalmologic problems were examined before and after cataract surgery (irrigation/aspiration procedure with implantation of a posterior chamber IOL). Twelve eyes also received a posterior capsulorrhexis and anterior vitrectomy. The mean age at surgery was 6.9 +/- 3 years (range, 3-12 years). RESULTS: Twenty (51%) of 39 eyes achieved a best-corrected postoperative visual acuity of 20/40 or better (range, 20/200-20/20). The mean postoperative visual acuity was 20/40 in the traumatic and developmental cataract groups and 20/100 in the congenital cataract group. There was a positive correlation between cataract morphology and visual acuity (P<.05). Bilateral cataracts had a better postoperative visual acuity than unilateral cataracts (P <.005). Nineteen (70%) of 27 eyes in which no primary posterior capsulorrhexis had been performed had posterior capsule opacification. Stereopsis was found in 10 of the 31 patients: 43% of the traumatic cataract group, 30% of the developmental cataract group, and 14% of the congenital cataract group. CONCLUSIONS: After capsular bag-fixated IOL, visual acuity and binocular function in children older than 3 years were favorable and the complication rate, excluding posterior capsule opacification, was low.

[Intravitreal endoscopic visualization of intraocular ganciclovir devices: improved long-term treatment of CMV retinitis]. / Endoskopische Kontrolle von Pars plana implantierten Ganciclovir-Medikamententrägern zur Verbesserung der Langzeitprognose bei der Behandlung der Cytomegalievirusretinitis.

BACKGROUND: The recent development of 20- and 19-gauge diameter endoscopes allows an excellent direct intravitreal visualization of intraocular morphology. A gradient index (GRIN) endoscope (Insight Instruments, Lake Mary, FL, USA), which combines a small diameter (0.89 mm, 20 gauge) and an exceptional optical resolution, can be used as a diagnostic tool for the assessment of the safety and vitreous interaction of sustained release intraocular devices which have been designed to deliver ganciclovir (Vitrasert) over a period of 8-12 months and were successively implanted in several eyes. PATIENTS AND METHODS: 78 eyes of 49 patients received 100 ganciclovir implants between November 1995 and July 1998. In six patients who received additional implants, the GRIN endoscope was used as an optical control of wound healing processes and Vitrasert positioning after implantation of prior devices (two-point suturing technique). RESULTS: In all of these six eyes, a clinical stabilization of the cytomegalovirus retinitis was noted. Endoscopic observation of the scleral 5-mm incision revealed no gaps after two-point suturing of the device. Only one of six eyes showed significant vitreous tractions around the Vitrasert. However, the struts of all pellets were completely covered by a fibrous membrane. Occasional fibrous plaques were noted on the surface of devices which presumably had been damaged by surgical manipulations. In one case, the endoscopic examination disclosed the suprachoroidal implantation of a device. In this eye, no signs of retinal toxicity or recurrence of CMV retinitis were observed. CONCLUSIONS: High resolution endoscopy of the vitreous cavity appears to be an effective method for the control of intraocular drug delivery devices. Basically, the repeated implantation of intraocular ganciclovir implants can be considered a safe method in the management of relapsing CMV retinitis. However, the endoscopic observation of fibrous membranes covering the struts suggest that the explanation of an intraocular device has the potential for various intraoperative complications (e.g. hemorrhages, traction, tears, retinal detachment). Therefore, we would recommend the additional implantation of further implants rather than a replacement.

Image analysis of implanted rigid and foldable intraocular lenses in human eyes using Scheimpflug photography.

We evaluated the quality of imaging posterior chamber intraocular lenses (PC IOL) by Scheimpflug photography. We took photographs of 190 rigid or foldable PC IOLs using the Scheimpflug system EAS-1000 from Nidek and provided digital image analysis. We found a good imaging of PC IOLs and the cristalline lens capsule, data obtained by digital image analysis were reliable and reproducible and Scheimpflug photography could be demonstrated as a sensitive tool to show any irregularities of IOL material. Thus, we found in foldable IOLs 'glistenings', which did not have any influence on functional results and we could distinguish them from lens damage. We propose to use Scheimpflug tests regularly for the examination of implanted new types of IOLs.

Fibrinolytic therapy with low-dose recombinant tissue plasminogen activator in retinal vein occlusion.

Fibrinolytic therapy aimed at early restoration of blood flow appears to be a promising therapeutic approach in haemorrhagic retinopathy. The risk of bleeding complications, a major problem with fibrinolysis, can be reduced by the use of low-dose thrombolytic regimens. In our study, 14 patients with ischaemic central (CRVO) or branch (BRVO) retinal vein occlusion who presented with severe visual loss and recent onset of symptoms were treated with a low dose (50 mg) of recombinant tissue plasminogen activator (rt-PA) and intravenous heparin. In 10 of 14 patients (7 CRVO, 3 BRVO), an increase in visual acuity of one line or more on the logarithmic visual acuity chart was noted and in 8 patients (6 CRVO, 2 BRVO) a reduction of areas of capillary non-perfusion was observed, suggesting that a restoration of retinal capillary blood flow can be achieved if fibrinolysis is initiated in the early phase of haemorrhagic retinopathy. In view of the poor prognosis in the natural course of haemorrhagic retinopathy and the potential haemorrhagic risk in fibrinolysis, the use of low-dose rt-PA appears to constitute an encouraging approach in the management of this disease.

[Correction of myopic astigmatism with the VISX 20/20 excimer laser. An overview of treatment outcome]. / Korrektur des myopen Astigmatismus mit dem VISX 20/20 Excimer-Laser. Eine Ubersicht über die Behandlungsergebnisse.

UNLABELLED: The advent of the excimer laser has brought about the potential for improved vision in many individuals with myopia and astigmatism. However, photoastigmatic refractive keratectomy (PARK) remains a matter of controversy. The purpose of our study was to determine the predictability of VISX 20/20 excimer laser photorefractive keratectomy in the treatment of myopic astigmatism. PATIENTS AND METHODS: Our study comprised 31 eyes of 22 patients with myopic astigmatism. All patients underwent treatment with a VISX 20/20 excimer laser and were followed up for 6 months. Complete 12-month follow-up data were available from 18 eyes. Park was performed in eyes with myopia between -1.5 and -10.0 D and with astigmatism between -0.5 and -5.5 D. Thus, the corresponding spherical equivalent ranged from -1.75 to -10.5 D. RESULTS: Six months postoperatively, 21/31 (62%) eyes were within +/- 1.0 D of the target refraction and 13/31 (42%) within +/- 0.5 D of the target refraction. In 13 of 15 eyes (87%) with myopia less than -6.0 D, an uncorrected visual acuity of at least 0.8 was noted. In eyes with myopia greater than -6.0 D, 9/16 (56%) showed an uncorrected visual acuity of at least 0.5. Six months after PARK, an increase of one line on the Snellen Visual Acuity Chart was observed in 8/31 (26%) and an increase of two lines was noted in eyes 3/31 (10%). One of 31 eyes (3%) showed an increase of three lines. A decrease in visual acuity of 1 line on the Snellen Visual Acuity Chart was found in 4/31 (13%), and in 3/31 eyes (10%) a decrease of 2-4 lines was noted. Overall, we observed a statistically significant reduction of astigmatism from 1.93 +/- 1.43 D to 0.93 +/- 0.63 D. Reduction of corneal astigmatism less than -1.25 D was not statistically significant. In eyes with astigmatism ranging from -1.25 to -2.5 D or greater than -2.75 D, a significant reduction of the mean astigmatism was noted. The postoperative regression of astigmatic correction was low. However, an axis shift of more than 15 degrees was found in 42%/35% of eyes by subjective refraction (miosis/cycloplegia) and in 33% in corneal topography. No central islands were noted. CONCLUSION: Photoastigmatic refractive keratectomy (PARK) constitutes a potential means of correcting myopic astigmatism. In eyes with astigmatism greater than -1.0 D a significant reduction of 60% of the mean astigmatism was noted. However, the considerable proportion of eyes with a postoperative axis shift greater than 15 degrees and a decrease in visual acuity of two or more lines indicates that further research is needed on excimer laser surgery to improve the reliability and safety.

[Toxoplasmosis retinochorioiditis, a therapy comparison between spiramycin and pyrimethamine/sulfadiazine]. / Toxoplasmose-Retinochorioiditis, ein Therapievergleich zwischen Spiramycin und Pyrimethamin/Sulfadiazin.

BACKGROUND: The treatment of toxoplasma retinochoroiditis with spiramycin is an alternative to sulfadiazine and pyrimethamine. The treatment with sulfadiazine is associated with multiple side effects. Sulfadiazine is contraindicated during pregnancy and breastfeeding period. Spiramycin has less side effects and is recommended during pregnancy and breastfeeding period. The efficacy of spiramycin in treatment of toxoplasma retinochoroiditis is still a matter of controversy. PATIENTS AND METHODS: In a retrospective study, side effects and outcome of therapy in 44 patients with toxoplasma retinochoroiditis treated with sulfadiazine and pyrimethamine (n = 30) or spiramycin (n = 14) were compared. We assessed duration of therapy and healing, ophthalmoscopic findings and observed side effects. RESULTS: The mean healing time in the group of spiramycin was 63.83 days in comparison to 88 days for the group of patients treated with sulfadiazine/pyrimethamine. The frequency of side effects was lower in the group treated with spiramycin. CONCLUSION: In comparison to a combined application of sulfadiazine and pyrimethamine the treatment with spiramycin alone requires a shorter duration of therapy and healing period. Additionally, side effects and contraindications appear to be less frequent. In view of these findings, spiramycin therapy must be considered as a promising approach in the treatment of toxoplasma retinochoroiditis.